LONELINESS IN OLDER ADULTS LIVING IN PUERTO RICO DURING THE COVID-19 PANDEMIC: AN UNDEREXAMINED PUBLIC HEALTH CONCERN

Abstract Loneliness is a critical public health problem, yet it is under-examined among older adults in Puerto Rico. We explored sociodemographic and health-related risks for loneliness using data from a Knowledge, Attitudes and Practices COVID-19 study of Older Adults in Puerto Rico study. We conducted telephone and face-to-face interviews (January - December 2021) with a nonprobability sample of adults aged 60+ in Puerto Rico (n= 213). Data collection included measures of objective and subjective physical and mental health. We used generalized linear regression analyses to explore main effects of salient demographic and health factors on loneliness. Missing data were treated with Multiple Imputation. Prevalence of loneliness (3-item TILS) was 36.3% . Widowhood (β=.832, SE=.38, p=.029), low household income (<$12,500; β=.691, SE=.23, p=.003), psychological distress (β=.141, SE=.03, p<.001) were positively associated with greater loneliness. Living alone (β=-.664, SE=.27, p=.015) and higher sense of community (β=-.067, SE=.01, p<.001) were negatively associated with loneliness. Pandemic specific challenges (e.g., someone close diagnosed or hospitalized with COVID-19) and other common predictors (e.g., age, female, self-rated health) were not significant. We consider that contextual (e.g., outmigration, under-resourced aging and healthcare infrastructure) and cultural factors (e.g., familism) may help shape predictors and their effects on loneliness. Mainland US and Puerto Rican researchers and practitioners should collaborate on examining loneliness narratives, their impact on health, and implementation of culturally appropriate and contextually feasible interventions in Puerto Rico.


THE SPILLOVER EFFECTS OF COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL: A STUDY FROM CALIFORNIA Narae Kim, and Mireille Jacobson, University of Southern California, Los Angeles, California, United States
In 2016, Medicare implemented the Comprehensive Care for Joint Replacement (CJR) program to test whether paying hospitals a bundled payment for 90 days of an episode of care for lower extremity joint replacement (LEJR), the most common surgery for Medicare beneficiaries, can improve care coordination and quality in traditional Medicare (TM).Unlike most Medicare alternative payment models, CJR participation was randomly assigned across Metropolitan Statistical Areas (MSAs).Hospitals in selected MSAs were required to participate in the program, while hospitals in other MSAs were paid in the usual feefor-service manner.Taking advantage of this random assignment, we examined CJR's direct effects on TM patients and spillover effects on Medicare Advantage (MA) and non-Medicare patients in California.Using California's Patient Discharge Data (PDD) from 2014 to 2017and event study and difference-in-differences models, we studied changes in adjusted length of stay and home discharge rates before and after program implementation in hospitals in treated versus control MSAs.We found that the CJR program affected not only TM patients, but also untargeted MA and non-Medicare patients.Both TM and non-Medicare patients in treated hospitals experienced shortened length of stay (-3.9% & -1.3%, p<0.05) and increased likelihood of discharge home (3.4%, 2.3%, p< 0.001) relative to those in untreated hospitals after program implementation.MA patients experienced an increase in not only home discharge rates (4.7%, p< 0.001) but also length of stay (2.5%, p< 0.01).Programs designed to affect Medicare costs have the potential to affect the care of patients not covered by the program.Loneliness, defined as the perceived discrepancy in an individual's desired and actual social relationships, is common among older adults.Loneliness among older adult primary care patients is lacking, considering the implications it has on physical and mental health.Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult primary care patients.Data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among older primary care patients and their family members.Loneliness (5-item NIH Toolbox), quality of life (QOL)-as measured by physical and mental health component scoresand depression (PHQ-9) and anxiety symptomatology (GAD-7) were measured among primary care patients aged 65 and older from April 2020 to September 2021.Spearman correlation analyses reveal that loneliness was moderately correlated with mental health (r(601) = -.43,p< 0.001), anxiety (r(601) =.44, p< 0.001), and depression (r(601) = .42,p< 0.001), while weakly correlated with physical health (r(601) = -.15,p< 0.001).After conducting unadjusted and adjusted linear regression models, we found that loneliness was associated with both lower mental (p< 0.001) and physical health component scores (p< 0.001).Furthermore, loneliness remained significantly associated with worse mental health when adjusting for depression, anxiety, sociodemographic characteristics, and comorbidity.Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

SOCIAL SUPPORT AND HEALTH
Abstract citation ID: igad104.1994Loneliness is a critical public health problem, yet it is under-examined among older adults in Puerto Rico.We explored sociodemographic and health-related risks for loneliness using data from a Knowledge, Attitudes and Practices COVID-19 study of Older Adults in Puerto Rico study.We conducted telephone and face-to-face interviews (January -December 2021) with a nonprobability sample of adults aged 60+ in Puerto Rico (n= 213).Data collection included measures of objective and subjective physical and mental health.We used generalized linear regression analyses to explore main effects of salient demographic and health factors on loneliness.Missing data were treated with Multiple Imputation.Prevalence of loneliness (3-item TILS) was 36.3% .Widowhood (β=.832,SE=.38, p=.029), low household income (<$12,500; β=.691, SE=.23, p=.003), psychological distress (β=.141,SE=.03, p<.001) were positively associated with greater loneliness.Living alone (β=-.664,SE=.27, p=.015) and higher sense of community (β=-.067,SE=.01, p<.001) were negatively associated with loneliness.Pandemic specific challenges (e.g., someone close diagnosed or hospitalized with COVID-19) and other common predictors (e.g., age, female, self-rated health) were not significant.We consider that contextual (e.g., outmigration, under-resourced aging and healthcare infrastructure) and cultural factors (e.g., familism) may help shape predictors and their effects on loneliness.Mainland US and Puerto Rican researchers and practitioners should collaborate on examining loneliness narratives, their impact on health, and implementation of culturally appropriate and contextually feasible interventions in Puerto Rico.

LONELINESS IN OLDER ADULTS LIVING IN PUERTO RICO DURING THE COVID-19 PANDEMIC: AN UNDEREXAMINED PUBLIC HEALTH CONCERN
Abstract citation ID: igad104.1995

SENSE OF CONTROL AND DIGITAL LITERACY AMONG OLDER ADULTS: THE ROLE OF PERSONAL MASTERY AND PERCEIVED CONSTRAINTS
Zhiyu Fan, Huamao Peng, Heng Zhao, and Jingxuan Wu, Beijing Normal University, Beijing, Beijing, China (People's Republic) Digital literacy (DL) is necessary for older adults to fully participate in society in the era of digital technology.This study investigated how the sense of control (SOC) and its two internal dimensions (personal mastery (PM) and perceived constraints (PC)) interact with DL among older Chinese adults.A total of 163 older netizens aged 60 to 76 (Mean age 66.0, SD = 3.57, 72.4% female) were recruited from Beijing in 2021 through convenience sampling and followed for 1 year.DL was measured by a self-designed Digital Literacy Scale among Older Adults (Range 1-5; Cronbach's α = 0.96) and SOC was measured by the Sense of Control Scale (Range 1-7; Cronbach's α = 0.88).Cross-lagged analysis and half-longitudinal mediation analysis were used after adjusting for age, gender, and education.The DL were 3.51 and 3.52 at baseline and year-1 on average.Higher baseline SOC (Adjusted beta = 0.23, 95% Confidence Interval = [0.08,0.38]) and PM (0.26 [0.10, 0.42]) were associated with higher year-1 DL.Higher baseline DL was related to reduced year-1 PC (-0.16 [-0.30, -0.02]).In addition, halflongitudinal mediation analysis showed that higher PM at baseline predicted an increase in DL from baseline to year-1 (0.29 [0.13, 0.43]), whereas higher baseline DL was related to a decrease in PC from baseline to year-1 (-0.16 [-0.30, -0.03]).Our findings indicate that the DL of older netizens is closely related to their internal factors.Older netizens might benefit from better SOC, especially personal mastery, thus narrowing the secondary digital divide.

SOCIAL ENGAGEMENT IN OLDER PEOPLE LIVING WITH HIV
Atami De Main 1 , Marshall Glesby 1 , Carrie Johnston 1 , Mark Brennan-Ing 2 , and Eugenia Siegler 1 , 1. Weill Cornell Medicine,New York City,New York,United States,2. Hunter College,CUNY,New York City,New York,United States More than 50% of people with HIV (PWH) are at least 50 years old.PWH experience a high prevalence of multiple chronic conditions and fragile social structures.Although social engagement may be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence on older PWH's social engagement and associated factors in engaging with family, friends, and community.This study sought to examine social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study at the Weill Cornell Campus in New York City.We conducted factor and regression analyses to characterize social engagement activities and examine their relationships with AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors.PWH (n=349, age range=50-84) were less engaged in social (Mean=1.31;SD=0.71) and cultural-physical (e.g.attending cultural events) (Mean=1.55;SD=0.78) than media-based activities (Mean=3.09;SD=0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively.Having AIDS, experiencing increased HIVrelated stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p < .001).High SVI score and financial strain were negatively associated with engagement in culturalphysical activities (F(5, 317) = 2.61, p < .001).Increased depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p < .001).The findings provide foundations for future research to improve our understanding of social engagement in older PWH.
Abstract citation ID: igad104.1997Background: Social support and self-efficacy play a significant role in improving positive psychological well-being in marginalized older adults.However, to date, there are few studies on identifying the relationships during the COVID-19 pandemic.We examined the effect of social support and self-efficacy on hopefulness in marginalized low-income older adults during the COVID-19 pandemic.Methods: This study used baseline data from a clinical trial designed to increase COVID-19 testing in Essex County, NJ.The dataset

LONELINESS AND QUALITY OF LIFE IN OLDER ADULT PRIMARY CARE PATIENTS
Soonhyung Kwon 1 , Ellen Benoit 2 , and Liliane Windsor 3 , 1. Rutgers, the State University of New Jersey, Savoy, Illinois, United States, 2. Center for Drug Use and HIV/HCV Research, NYU School of Global Public Health, New York City, New York, United States, 3. The University of Illinois at Urbana-Champaign, Champaign, Illinois, United States